Sabina, a 4-year old
Rottweiler, clearly wasn't happy. She limped across the
floor of a treatment room at SOL Companion, a canine
rehabilitation center in Oakland, Calif., refusing to put weight
on one of her hind legs.

"We think it's
something neurological," said Nina Patterson, a physical
therapist (PT) and the center's co-owner. It's difficult
to rehabilitate a gimpy leg, however, when your patient can't or
won't use the limb. That's where an innovative therapeutic
tool, the underwater treadmill, can help.

Veterinary technician Amy Mayfield led Sabina into a large box enclosed
with thick, clear plastic. A standard looking treadmill
sat on the bottom. Sabina stood on the treadmill, her
weight on three paws, eyeing liver treats Mayfield held at the
ready. Mayfield reached for the controls, and heated water
slowly began to seep into the treadmill chamber. Sabina
waited patiently. When the water reached about chest
height, the water flow ceased, and the treadmill began to move.

Sabina moved with
it, her injured paw touching down tentatively at first, then
more confidently as she strode along. When she exited the
unit after a 15-minute session, her limp had diminished
noticeably.

Sabina's story helps
explain why enthusiasm is growing about the underwater
treadmill, which was first used on canines about four years
ago. Julie Stuart, MS, PT, at Tufts University School of
Veterinary Medicine, said her dream setup for rehab includes an
underwater treadmill.

Good
for Arthritis

"It's
great for orthopedic dogs, dogs with arthritis or with hip
dysplasia," she said. "In water, they can
exercise pain-free because it takes away the weight
bearing. The buoyancy makes them bear less weight on their
joints, yet it's resistive."

That
combination of buoyancy and resistance makes using the
underwater treadmill attractive in therapeutic work. John
Sherman, DVM, an affiliate of North Carolina State College of
Veterinary Medicine in private practice, has used a unit for
nearly two years.

"It's
a powerful tool," he said. "Let's say a dog
weighs 100 pounds on land. You could have him walk [in
water] so he'd only weigh 40. You can get dogs walking and
returning to function quicker with an injury or surgical
repair."

The
concept of the underwater treadmill is obvious: Partially
submerge a dog in water and let him walk on the treadmill.
Heat the water for comfort -- the temperature in the unit Sabina
used is kept between 86 and 90 degrees Fahrenheit -- and treat
it with a chemical like chlorine or bromine to reduce bacteria
levels.

Technicians
adjust the intensity of exercise by adjusting the treadmill's
speed and angle, or by adding a current to the water. They
harness or leash dogs -- or both -- for safety and closely
monitor them throughout the session. The treadmill is
modeled after a pool or spa, with full filtration and the motor
safely enclosed away from water.

The
higher the water level on the dog, the less weight he
bears. When a dog walks on land, his forelegs bear 64
percent of his weight and his rear legs, 36 percent, said
Patterson, the physical therapist. In water at hip level,
those percentages change dramatically.

"It
actually alters the way the dog bears weight," she
said. "In the water, the rear legs almost float and
bear only 28 percent of the dog's weight, while the forelegs now
take up 72 percent of the load."

Said
Donna Chisholm, PT, who also works at SOL Companion: "You
get all the benefits of buoyancy along with a reduction of
compression forces. Using the underwater treadmill
addresses all areas: balance, stability, conditioning,
strength."

Limited
Sales

If
so many rehabilitation specialists are gung-ho about the units,
why aren't they everywhere? According to Allan Dahl,
director of aquatic therapy for the manufacturer Ferno, only 53
of the company's K9 Underwater Treadmill Systems have been sold
since production began four years ago.

One
factor may be price. Ferno's underwater treadmills range
from $14,500 to $50,000. At Tufts, Stuart cited cost as
the reason she chose instead to purchase a spa-pool.

Dahl
believes the bigger issue is simply the fact canine
rehabilitation itself is new. Only an estimated 30
to 40 facilities in North America are devoted specifically to
dogs.

"Rehab
is becoming an important tool in veterinary medicine," he
said. "But getting the vets to accept that therapy is
important is taking some time."

Dr. Sherman
agreed rehabilitation is a new science for his profession.
When he graduated from veterinary school in 1993, students
learned to perform a surgery and then crate the dog for six
weeks, with time outside only for elimination. The dog
would then walk on leash for another six weeks.

"That
was it," he said. "That was rehab. Or you
swam them, but really, swimming for a hind-limb injury is just
not that effective a therapy."

That
mindset began to change when human physical therapy became
popular. Some veterinarians and physical therapists began
considering translating human therapeutic modalities to the
canine world. One was Laurie McCauley, DVM, an Illinois
veterinarian in private practice. Four years ago she
approached Ferno, which at the time was making underwater
treadmills for human and equine use.

"They
thought I was crazy, but they worked with me," she
said. "It's such a great exercise, but it's safe for
a 90-year-old lady with a hip replacement. So I thought it
would be great for arthritic dogs."

Dr.
McCauley gave Dahl a wish list. In return, Ferno developed
its first canine underwater treadmill, a unit that attached to
her existing pool and used a Jet-Ski lift to vary the water
height. Today, Dr. McCauley has two underwater treadmills
at her TOPS Veterinary Rehabilitation center in Grayslake, Ill.
and said about a dozen dogs a day benefit from them.

Run
Up Stairs

"I've
had dogs with neurological injury that have used their legs a
full two weeks in the water before they used them on land,"
said Dr. McCauley. "A lot of the arthritic dogs do
great with it. Their owners tell me they go home and are
running up and down stairs, doing things they haven't done for
six months."

David
Levine, Ph.D., PT, Orthopedic Certified Specialist, American
Board of Physical Therapy Specialties, adjunct associate
professor at the University of Tennessee at Chattanooga's
College of Veterinary Medicine, echoed her enthusiasm. The
university was an early adopter of the underwater treadmill and
worked with Ferno to design and modify the first units.

"I
think early on, especially early post-operatively, it's a really
wonderful rehab tool to get (a dog) to start using a limb a lot
easier than we normally could have outside with just
walking," he said. "It's enhanced our ability to
rehabilitate post-op dogs more quickly and to a higher
level."

Dogs
generally seem to like the underwater treadmill. "The love
the warm water (kept at 90 to 94 degrees, depending on the
weather) and the massage at the end," Dr. McCauley said.

"They're
in their element," said Chisholm. "They
walk. They swim."

A few don't
enjoy the water, however, and some don't know what's expected of
them. Dr. Sherman recalled a dog who couldn't understand
the concept of water and walking. "He either wanted
to lay down or try to swim."

Of course,
the people operating the treadmills need to be knowledgeable
about their work. "The underwater treadmill, like
anything, is just a tool to be used," said Dr.
Sherman. "If you just put a dog in there and expect
him to get better, you can get into trouble. Every patient
that comes in, you have to give a full physical exam, see where
they are in the healing process and monitor their
progress. In the wrong hands, if you just turned it on and
didn't know what you were doing, that would be a problem."

Set
up a Schedule

The
underwater treadmill should be used as part of an overall
treatment plan rather than it's sole focus. For example, a
typical surgical rehabilitation schedule at SOL Companion would
begin one to two weeks post-operatively and include passive
range-of-motion exercises three times a day, daily walking from
up to 10 minutes at at time and crating to limit movement.
A month to six weeks later, the dog would begin two to three
sessions where he'd undergo hands-on tissue work, hydrotherapy
and movement therapy, while continuing at-home work with the
owner.

The cost
of animal rehabilitation varies with the provider but generally
ranges from $50 to $125 per session. Most therapists' fees
are based on time rather than on equipment although some bill
differently for a hydrotherapy-only session. For example,
Dr. Sherman charges a flat rate of $120 for an hour, regardless
of modalities used. Dr. McCauley bills $49 per session, up
to 20 minutes, for hydrotherapy, with other treatments at an
additional charge. SOL Companion's rates are $75 for an
hour of hands-on work, $50 for a half-hour with the underwater
treadmill and $125 for a combination of both.

Those
best qualified to work with dogs on the underwater treadmill
include physical therapists who've expanded their practices to
include dogs and veterinarians or veterinary technicians who
have formal training in animal rehabilitation.

Currently,
there's no such title as an "animal physical
therapist," although some specialized training programs
exist. The term "physical therapist" is reserved
for professionals who work with humans.

While
some dogs respond very well, hydrotherapy shouldn't be viewed as
the magic bullet, Patterson warned. Her center, which has
one underwater treadmill but is chock-full of therapeutic
equipment, including balance boards, oversized balls and even a
mini-trampoline, bears her out.

Still,
it's a promising therapy that could become a new standard of
care. And while results so far are strictly anecdotal --
no rigorous studies of outcomes have been done -- word of mouth
has been encouraging. Dr. Sherman believes the treadmills
someday will be available in every major metropolitan
area. "In my opinion, this will be an up and coming
veterinary specialty."

As for
Sabina, she's still in rehab. Patterson said her case is
trickier than most. "She'd be improving much more
quickly if this were a surgical rehab rather than a nerve
entrapment, which is what we suspect is going on," she
said, but she still showed marked improvement. Her time on
the underwater treadmill has increased from 8 to 20 minutes and
the prognosis is good.

"When
we first saw her in November 2002, she was completely non
weight-bearing with her left hind limb on hard surfaces,"
Patterson said. "Now, although it's still
intermittent, she's able to bear weight."

Thanks
to the underwater treadmill, Sabina's on her way to becoming
another rehabilitation success story.